About twice as many women as men suffer from depression, according to National Institutes of Mental Health statistics. For many women, the first episode of depression or dysphoria--which includes bouts of anxiety, irritability and depression--strikes in the delicate transition from adolescence to adulthood.
Though the compassion and support of loved ones can soften the devastating blows of depression, two studies suggest that depression in adolescent girls and young women can obliterate their ability to experience and benefit from the much needed support offered by best friends and family.
Shannon E. Daley, assistant professor of psychology at USC, and Constance Hammen, professor of psychology at UCLA, studied differences between adolescent friendships and romantic relationships in the lives of 138 girls and women, age 16 to 19, from middle-class neighborhoods in Los Angeles County. Seven times, over a five-year period, the researchers tracked and assessed the depressed girls, as well as their boyfriends and best friends, according to the study published in the February issue of the Journal of Consulting and Clinical Psychology.
The researchers found that while best friends reported intensifying support, love and empathy as the friend's depression worsened, the depressed teenager did not perceive the efforts as support or empathy.
By contrast, with boyfriends who admitted to often being unsupportive and cold during depressive episodes, the depressed teenagers' perceptions appeared to be more accurate.
A number of studies show that for people with mental health problems, the perception of support may be more important than actual support. In fact, experts say, skewed perception is a natural outgrowth of depression.
"The friends of depressed girls said they provided increased support, listened to the person's problems and provided reassurance, love and affection" as the girl became more depressed, said Daley, lead author of the study. "Best friends may really be telling the truth and providing more support, but if the depressed women don't see it, they may not benefit."
"When people are depressed, they look at the world through gray-colored glasses," said Gina Rayfield, a counseling psychologist in Randolph, N.J., who specializes in adolescent development and practices. "The depressed adolescent is not picking up on the cues of support from their best friends. They tend to project their feelings of 'I am not good enough,' onto others, and the assumption is everyone else must be thinking that too."
As for boyfriends, Rayfield said that many adolescent boys she sees in her practice "are not keenly aware of their own feelings" and are not developmentally mature enough to be supportive of a depressed girlfriend. Many of the depressed young women in the study were in dysfunctional relationships with partners who were aloof, cold, volatile and anxious.
"Depressed girls are more likely to pick boyfriends who are bad for them," Daley said. "We don't know why yet."
What is clear from the research, Daley said, is that as depressed girls make the transition from adolescence to adulthood, it is in their best interest to maintain close female friendships, because that is where they stand the best chance of receiving emotional support and comfort.
"Depressed women should also be aware of the kinds of partners they are choosing,'' Daley said. "They may be choosing the very partner who won't be there for them."
In another study on the topic, psychologists examined the relationships of 55 depressed, college-age women who were rated as holding extremely high expectations of their loved ones (under the label "other-oriented relationship perfectionism'').
In their report, published in the March issue of the Journal of Social and Clinical Psychology, Scott B. McCabe, an associate professor of psychology at the University of Waterloo in Ontario, Canada, and Robyn E. Wiebe, a University of Waterloo graduate student found that depressed women often have such extreme expectations of how people should treat them that they became hostile, angry, frustrated and irritable when loved ones fall short, no matter how sympathetically they are treated.
"Relationship perfectionism in depressed women is linked to hostility and irritability in interpersonal relationships," said McCabe, who said the study was the first to explore the effects of perfectionism in interpersonal relationships. The study was an outgrowth of McCabe's clinical work in psychiatric hospitals, where he noticed some depressed female inpatients would return from weekends home enraged, disappointed and hostile.
McCabe offers the case of one such inpatient, a depressed woman in her 30s: "Her family had really cleaned up the house, and they had put flowers on the table for her," recounted McCabe. "But they had tickets for a sporting event that night [that] she didn't want to attend. She wanted to be with them in the way she expected. She was very angry and quite upset."